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Findings

A written finding is a formal document handed down by a coroner following an investigation into a death or fire and is generally the final step in the coronial investigation process. A written finding is made regardless of whether an inquest is held or not.

A written finding following an investigation into a death will usually, if possible, include:

  • the identity of the person who died
  • the time, date, and location where the death occurred
  • a summary of the evidence relating to the circumstances of the death, in some cases
  • comments or recommendations made by the coroner aimed at preventing similar deaths, in some cases.

Findings are published when:

  • an inquest was held
  • recommendations have been made
  • a coroner otherwise orders they be published.

Findings handed down and published are available below.

Search older findings on the Australasian Legal Information Institute database (AustLII).

Please consider that it may be upsetting to read details about a death or fire in an inquest finding. Some information may be graphic or distressing.

Use the search field above to locate a finding. You can search for a name, a case number, type of death or location of death.

Any person may apply for some or all of a finding to be reviewed and/or appealed.

Recommendations

The Coroners Act 2008 allows a coroner to make recommendations as part of their finding following an investigation into a death or fire.

Recommendations can be made to any Minister, public statutory authority or entity that may help prevent similar deaths. A public statutory authority or entity who receives a recommendation from a coroner must respond, in writing, within three months stating what action, if any, has or will be taken.

The Court will publish inquest findings with recommendations and the subsequent responses below.

Findings list

Name Case ID Case type Date Sort ascending Coroner Related orders and rulings Responses to recommendations
Adam Slomczewski COR 2015 6241 Finding into death with inquest 13/09/2017 State Coroner Judge Sara Hinchey
Nancy May Budge COR 2016 5227 Finding into death with inquest 11/09/2017 State Coroner Judge Sara Hinchey
Patricia Shaw COR 2015 5494 Finding into death with inquest 11/09/2017 State Coroner Judge Sara Hinchey
Baby Minahil Bhatti COR 2017 0288 Finding into death without inquest 11/09/2017 Coroner Audrey Jamieson
Pamela Louise Elsdon COR 2016 5554 Finding into death without inquest 07/09/2017 Coroner Audrey Jamieson
Vincenzo Mannella COR 1999 0094 Finding into death with inquest 31/08/2017 State Coroner Judge Sara Hinchey
Kenneth Albert Hargreaves COR 2017 1065 Finding into death without inquest 31/08/2017 Coroner Jacqui Hawkins
Gianni (John) Furlan COR 1998 2331 Finding into death with inquest 31/08/2017 State Coroner Judge Sara Hinchey
Les Samba COR 2011 0762 Finding into death with inquest 31/08/2017 State Coroner Judge Sara Hinchey
Frederick Hylla COR 2016 4011 Finding into death without inquest 28/08/2017 Coroner Audrey Jamieson